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TYPE OR PRINT ONLY <br />PUBLIC N'G.JRKS PERMIT <br />PUBLJC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everott, WA 98201 25&8810 <br />o��a � . <br />Publk Works PertnH N <br />Building Permk N _ <br />Publk Nbrks Fee S — <br />Plan Check No: C 59772 SEPA <br />Applicat.Date: OB/06 98 <br />p�ef Job A dreee: 82Y G D AVE <br />Owner: LANE SHAWN <br />Tenant: <br />Propoeed Uee: SINGLE FAMILY AESIDENCE <br />���� Deec. of Work: <br />ADD BATHAOOM DORMER <br />DBSCflb9 PfOpOSBCJ WOrIC _ OFFICE SET JOB <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />PROJECT ADDRESS (if known) <br />Phone <br />Attnch four (4) copbs ot plans tor proposed vrork - Draw to scale and note the folbwing H applicable: <br />'Property Lines 'Outllne arW dime� isions of all existing and proposed stnrctu2s on the bt 'Existing end qoposnd utilNles <br />'Centerline ol shaet 'Indkate North 'Show eny proposed greding changes 5how measuremants <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Speciflcations. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4245555. <br />?UQLIC WORKS �ERMI"} <br />h0 RfiOUIqEl1 <br />�Y. <br />MT6 •.----��� _ �� <br />Approved lor ConsWction Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />ACKNOWLEDGEMENT OP CONDfT10NS <br />The undersigned owneNapplkant Aereby agraes to hold and save hartnlsas <br />the City of EveraH trom eny and all claims 1or darnspes, costs, expenses, a <br />causes of eclbn thet may e�isu because of imtallatbn and rtWnterw�es of <br />tha Gnprovetnent or other ripM-of•way use haeto epQlbd fa and hirther egieee <br />to rertave� same upon notke fiom the City and to replace pubNc property <br />damaged thereby. <br />Signature ot Applkant pe�e <br />WORK AUTHORIZED BY THIS PERMR MUST BE STAHTED WITHIN 1 BO DAYS OF DATE PERMR IS ISSUED AND THEREAFTER IS TO BE DILN3ENTLY PURSUED TO <br />COMPLETION. THIS PERMR MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOHK ON THIS PRQIECT OVER 90 DAYS WRAT70N. <br />